Paying for Healthcare - The Future of the NHS?

2015 promises to be another momentous year for the NHS. With the general election less than 100 days away, how our health service will be funded by the various political parties is likely to be a hot topic for the manifestos, with the prospect of paying for some services at the point of use a controversial future inevitability according to some health service experts.

Paying for healthcare is something I'd had no experience of until my recent trip to South Africa. I became unwell and needed to see a doctor, and whilst as a tourist I had travel insurance, the process meant that I still came face-to-face with the reality of paying for healthcare.

As a new patient I had to fill out forms prior to seeing the doctor, but before the usual questions about allergies and long-term health conditions, there was a section devoted to who was going to pay my account and their details - for South African residents this included a declaration related to their medical aid (insurance) provider.

On handing the forms back, I also had to hand over my credit card: no payment, no consultation. The same process was repeated for my blood tests - done at a laboratory separate to the doctor's surgery and at a considerably higher cost than my consultation with the doctor. The very real possibility existed that a patient without enough money, or medical aid provision, would simply avoid the blood tests altogether.

Granted, I had significantly longer than 10 minutes with my doctor; she wasn't just interested in my health concern and examining me, but also asked me about my life generally and we talked about my dementia work. I can imagine many a patient in the UK, particularly someone older who is maybe isolated or lonely, would really appreciate having a consultation with their GP that could easily last the best part of 20-30 minutes.

I can certainly say that I had value for money, although in common with just about every doctor's appointment I've ever had, I still came away wishing I'd asked more questions. In that respect, maybe all the time in the world never quite sets the patient's mind free to ensure that they walk out of the GP's surgery without anything unexplained or unanswered.

Did I get better any quicker because I had longer with my doctor and paid for the service? No, although in my case it was an illness that was going to have to take its course and all the doctor could do was give me advice and medication. The blood test results were very speedy (delivered on the same day the tests were taken), but I also had to contend with arguably the most unfriendly phlebotomist I have ever met, a lady who first took money and then took blood.

Perhaps ultimately that's the problem. I've only ever known NHS care. Free at the point of use, with professionals of all medical disciplines who only ask me about my bodily concerns not my financial health. Something feels fundamentally uneasy to me about bringing a payment structure into healthcare, however much it may deter those who abuse the NHS.

My overarching anxiety, though, isn't for someone like me - young-ish, relatively fit and well with no long-term health conditions - but for people who through no fault of their own are unwell, or ageing and developing health concerns. They may be able to pay for healthcare, but that could mean sacrificing some of the other things we encourage people to do in order to keep themselves healthy like maintaining a warm, dry home, keeping to a balanced diet with lots of fresh fruit and vegetables, taking exercise and maintaining an active social life.

For anyone with a long-term degenerative condition, like Alzheimer's disease, the bill over a period of many years could not only become astronomical, but directly deter them from seeking medical help during the different stages of their illness, including at the very beginning. Equally, we know that many health conditions, including the different cancers, need to be caught early to have the best chance of successful treatment.

The NHS may have its faults, but having experienced paying for healthcare my overwhelming feeling it that there are many things the UK could sacrifice, but a free at the point of use healthcare system shouldn't be one of them. For me, cutting future healthcare liabilities lies, albeit not exclusively, in education and prevention, but that is a blog for another day.